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3.1 The feeding decision

What is most influential?

Demographic data, such as age, ethnicity, social class, education, etc may be used to predict feeding decisions. These, however, are rarely amenable to change.

Less well known are psychosocial variables. Researchers found that maternal attitudes are better predictors of feeding method than are sociodemographic factors,1 and that a woman's prenatal intention was a stronger predictor than the standard demographic factors combined.2 Fathers' attitudes also influence maternal decisions.3

In a study of women who were already breastfeeding 95.5% gave breastmilk as being better for the baby as the major reason they chose to breastfeed, with convenience for the mother another common reason. Another researcher4 explored why both breastfeeding and artificial formula-feeding mothers chose their method of feeding. They found ...
  • Mothers chose to feed artificial infant formula

    • not because they embraced artificial infant formula-feeding, rather that they rejected breastfeeding
    • found breastfeeding embarrassing
    • feared the pain or discomfort
    • felt it limits freedom and social life
    • were concerned that the father would not be involved
    • but acknowledged that human milk is better for the baby
  • Mothers who chose to breastfeed had the following in common

    • a positive attitude toward breastfeeding and human milk
    • considered human milk to be healthier or 'better' for babies than artificial infant formula
    • felt breastfeeding was more natural
    • felt it resulted in better bonding or closeness with the baby
    • and their self-confidence was linked to longer duration of breastfeeding

Mothers' greatest concerns about breastfeeding were found to be:
• breastfeeding in public,
• combining breastfeeding and working, and
• management of breastfeeding by health professionals5

Pregnant women are influenced in their attitude towards breastfeeding and will tend to adopt similar attitudes and opinions to that of their health care provider. Women who are encouraged to breastfeed by their doctor or nurse are more than four times as likely to initiate breastfeeding as women who do not receive encouragement.6

Play your part...

This is an indication of the mother's respect for her health provider's opinion, and the responsibility that rests on your shoulders to be a positive influence on pregnant women at a time when they are so open to receiving information.
You have a very important role to play in encouraging a positive breastfeeding attitude.

Influencing attitudes

Look again at the reasons mothers have given for them to artificially feed, and what mothers' concerns about breastfeeding are. Be aware that these personal attitudes may exist for some women.
Could a small group at your workplace look at ways to address each of those concerns even if a mother hasn't mentioned it herself. They may, for example, develop a poster with photographs showing how a mother could breastfeed discreetly in public, etc.

Guilt and not breastfeeding

This is a good opportunity for you to re-read about how feelings of guilt develop in the infant feeding decision. Understanding this will assist you to communicate effectively with pregnant women.

But not everyone can breastfeed!

That is true. Physically a small percentage of women, perhaps up to 5%, 7 are not able to meet all of their infant's nutritional needs. For these women and their infants the choices are few - donor breastmilk, or wet nursing is not possible for the majority and therefore we are to be grateful that artificial infant formula has been developed that will at least meet the majority of an infant's nutritional needs.

For other infants breastmilk may be contraindicated.8 These include:
  • Infants with inborn errors of metabolism who require special formulations:
    • classic galactosemia
    • maple syrup urine disease
    • phenyloketonuria, though some breastfeeding is possible, and desirable, under careful monitoring
  • Mothers who may need to avoid breastfeeding
    • HIV positive, but only when replacement feeding is acceptable, feasible, affordable, sustainable and safe
  • Mothers who may need to avoid breastfeeding temporarily
    • severe illness, eg sepsis
    • herpes simplex virus (HSV-1) on mother's breast where it will contact the infant's mouth (though breastfeeding from the other breast would not be contraindicated)
    • medication usage: cytotoxic chemotherapy; radioactive iodine-131 (safer alternatives are available); excessive use of topical iodine, eg on open wounds or mucous membranes; some sedating psychotherapeutic drugs, anti-epilepsy drugs, opioids though safe alternatives are usually available; drugs of addiction

What should I remember?

  • The factors which most influence a woman's infant feeding decision
  • The prenatal circumstances which can positively influence the maternal attitude towards breastfeeding
  • Your role as a health professional in relaying a positive breastfeeding attitude to all women
  • An understanding of the reasons why mothers chose to artificially feed their infants
  • When breastfeeding is contraindicated

Self -test quiz

Notes

  1. # Dungy CI et al. (1994) Maternal attitudes as predictors of infant feeding decisions
  2. # Donath SM et al. (2003) Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: a cohort study
  3. # Freed GL et al. (1993) Effect of expectant mothers' feeding plan on prediction of fathers' attitudes regarding breast-feeding
  4. # Brodribb W et al. (2007) Identifying predictors of the reasons women give for choosing to breastfeed.
  5. # McIntyre E et al. (2001) Attitudes towards infant feeding among adults in a low socioeconomic community: what social support is there for breastfeeding?
  6. # Lu MC et al. (2001) Provider encouragement of breast-feeding: evidence from a national survey
  7. # Spence JC (1938) The Modern Decline of Breast-Feeding
  8. # World Health Organization (1998) Evidence for the ten steps to successful breastfeeding